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Nosocomial bacterial pneumonia in human immunodeficiency virus infected subjects: incidence, risk factors and outcome

Depts of ¹ Infectious Diseases, ² Radiology and ³ Microbiology, Catholic University

CORRESPONDENCE: M. Tumbarello, Istituto Malattie Infettive, Università Cattolica, Largo A. Gemelli 8, 00168, Roma, Italy. Fax: 39 063054519

Keywords: acquired immune deficiency syndrome, human immunodeficiency virus, nosocomial bacterial pneumonia, risk factors

Received: June 6, 2000
Accepted September 19, 2000

The presented study examined the incidence, risk factors and outcome of nosocomial bacterial pneumonia (NBP) in human immunodeficiency virus (HIV)-infected subjects. Forty-two cases of NBP were ascertained by a 5-yr prospective surveillance and were matched to 84 controls. NBP incidence was 10.8 per 10,000 hospital patient-days. In particular, the incidence of NBP was 13.9 per 10,000 patient-days in the period 1994–1996 and 5.6 per 10,000 patient-days in the period 1997–1998 (p=0.01).

By using regression analysis, predictors for developing NBP were an increasing value of Acute Physiology and Chronic Health Evaluation (APACHE) III score (p<0.01) and the presence of acquired immune deficiency syndrome (AIDS)-related central nervous system (CNS) diseases (p=0.01). The additional hospital stay attributable to NBP was 15 days. The attributable mortality rate was estimated to be 29%.

Nosocomial bacterial pneumonia is more common in patients with advanced human immunodeficiency virus infection, high Acute Physiology and Chronic Health Evaluation III score and central nervous system diseases. Although the incidence of nosocomial bacterial pneumonia, as well of other opportunistic infections, decreased considerably in the era of highly active antiretroviral therapy, it still represents an important cause of mortality.